Haywood doctors open for business

The first stop for sick people in Haywood County should still be their local doctor.

Despite the implosion of services at Haywood Regional Medical Center, local doctors are still the best and fastest route for anyone needing medical care. Dr. Steven Wall, a pediatrician with Haywood Pediatrics, said sick patients can end up with a long wait if they simply head to a neighboring hospital and try to fend for themselves. If a child is sick and needs to be hospitalized, Wall will arrange a hospital room for the child to avoid wading through the ER for admission. The same goes for any patient with ailments.

One of the most common mishaps that could unexpectedly land someone in need of medical care falls under orthopedics — a broken arm, a twisted ankle, a sprained wrist. Dr. Jeffery Chain, an orthopedist with Western Carolina Orthopedic Specialists, said those patients can continue to be treated in his office or dispatched to the right place when necessary.

“If they fall and hurt their wrist and they aren’t sure if it is broken but it is sore and swollen, they can call us,” Chain said. “Our commitment is to try to do everything we can to take care of our patients and get them quickly triaged to the appropriate place to get the care they need.”

It’s far from an ideal situation, however.

“We feel sorry for the patients. It is horrible for them,” Chain said.

For emergencies, the doors of the hospital are still open. The hospital is treating emergency patients and absorbing the cost of their care if they are on Medicare or Medicaid. In addition to the cadre of ER doctors, specialists that partner with the ER are remaining on-call.

“If there is a emergency situation, something that is truly emergent, then we will come in and treat that patient and the hospital will treat that patient,” Chain said. “In cases where they need urgent care, but not emergent care, those are the things where the patient will have to go elsewhere.”

Chain is among 20 doctors from Haywood who have applied to practice at Harris Regional in Sylva, from surgeons to ophthalmologists. By week’s end, all the doctors who applied there should be approved. WestCare expedited the credential process so Haywood’s doctors could have somewhere to treat and operate on their patients as quickly as possible.

“The other hospitals are being wonderfully cooperative, both Harris and Mission,” Wall said. WestCare also runs the Bryson City Hospital, which also is opening its operating room to Haywood doctors.

Economic impact

Most doctors will inevitably see a loss of income, however. Some doctors rely solely on the hospital for their patients — like anesthesiologists who knock patients out for surgery or radiologists who interpret X-rays and scans taken on patients in the hospital. Others rely on the hospital to varying degrees.

“It is going to hurt us significantly,” said Chain.

As doctors see their income reduced, it will be hard to keep their offices running at full tilt.

“We love being in this county, but a lot of physicians are having a really hard time paying their overhead right now,” said Dionne Ghaussy, the wife of a doctor at HRMC. Ghaussy said one doctor in the county is selling his land so he can keep paying his employees. Doctors don’t have deep pockets like the hospital’s $20 million in reserves to fall back on.

“That is another side of this that isn’t being heard,” Ghaussy said of the doctors’ plight.

Dr. Nancy Freeman, chair of the hospital board, practically begged the public to keep seeing local doctors.

“Every physician’s office in the county remains open,” she said. “Don’t assume their doors are closed because they need you to continue to see them.”

Perhaps a larger challenge for doctors will come down the road when the hospital reopens: getting patients to come back.

“We realize there is a huge white elephant in the room, which is the lack of trust in medical care,” said Chain. “We are doing everything we can to try to smooth it over and try to get everything back on track as soon as possible. We want patients to be well-cared for and we want them to be confident they are getting good care.”

Empty beds

Meanwhile, the number of hospital patients has crashed. Out of 170 beds, only 25 were occupied as of mid-day Monday (March 3). Before the crisis, the hospital averaged 90 patients a day, marking a decrease of nearly 75 percent.

Many of the patients lingering in the hospital are left over from before the crisis hit. Patients already in the hospital when Medicare and Medicaid were yanked have a 30-day grace period to move to another hospital before their reimbursements cease.

There are some new patients still coming in, however. The hospital had only 18 patients Sunday, which went up to 25 by the next day, so the in-flow of new patients has not ceased completely. That’s not necessarily good news, however, since the hospital is doling out medical care for free to many of those patients.

Some of these patients are women having babies — a service the hospital has kept going. Even though the large majority of births at Haywood Regional — around 70 percent — are to Medicaid moms, the hospital is letting women deliver there anyway and is eating the cost.

Some of the patients being admitted to the hospital have come through the ER. If patients need more care after being treated in the ER, but aren’t stable enough to transfer, they get admitted to the hospital. Once again, the hospital is absorbing the cost of their care.